2017-07-12_REPORT - M1984069

• Permit No: M1984069
• IBM Index Class Name: REPORT
• Doc Date: 7/12/2017
• Doc Name: Annual Fee/Report/Map
• From: Schmaltz Construction
• To: DRMS
• Annual Report Year: 2016
• Email Name: DMC
• Media Type: D
• Archive: No

Page 5 of 5
Division records indicate the following permittee/landowner contact information(blank fields indicate that we do not have
information on record). If this information is blank or not current,please type or print current contact information:
Permittee Contact: Fred Schmalz
Permittee Company: Schmalz Construction Ltd
Address: P.O. Box 1105
720 S. 8th St.
Gunnison, CO 81230
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: /
Company: Schmalz Construction Ltd
Address: P.O. Box 1105
Gunnison, CO 81230
Phone Number: [phone]
Fax Number:
Email Address: i (•'(v
Inspection Contact: Pat�q
Company: Schmalz Construction Ltd
Address: P.O. Box 1105
Gunnison, CO 81230
Phone Number: [phone]
Fax Number:
Email Address:
I,the undersigned,hereby state that the information provided in this report is true and accurate, and that site operations are
being conducte ' ccordance with the Division approved mining and reclamation plans.
7/7�
Sig ure of Permittee Co orate Officer,Ow ,or Documented Designee a
M-AF-01